Remission of inflammatory bowel disease (IBD) has generally been defined as gaining control of inflammation and ending your symptoms and flares, which allows you to enjoy a better quality of life, according to the Crohn’s & Colitis Foundation. The organization estimates that about 50 percent of people with Crohn’s disease will be in remission or have mild disease over the five years after treatment. Now though, experts point out that there are many different ways to determine whether a person is in remission — and symptoms are only one piece of the puzzle. “Years ago, we were defining remission primarily based on clinical symptoms, such as less pain, normal bowel movements, and no blood in the stool, but we found that that, by itself, is not a very good indication,” says gastroenterologist Tanvi Dhere, MD, an associate professor at Emory University School of Medicine and director of inflammatory bowel disease at Emory University Hospital in Atlanta. It’s possible for people to achieve an even deeper remission, where “We can allow the inflammation and ulcers to heal,” she adds.
Clinical remission You have no symptoms and feel the same or better than you did before flares.Biochemical remission Markers of inflammation in your blood or stool, including levels of certain proteins, have improved.Endoscopic remission The lining of the affected area of your colon looks healed and healthy when examined during an endoscopy (an imaging test).Histologic remission In addition to clinical and endoscopic remission, a biopsy shows that the cells under the lining are healing and not inflamed.Surgical remission Surgery effectively removed areas with active Crohn’s disease.
Your doctor can help you find ways to achieve remission.
How I Got to Remission: Two Journeys
Amy G., 31, of Cincinnati, Ohio, went through five years of trial-and-error treatments, including sulfasalazine, a short course of prednisone, and dietary restrictions, until she found a drug combination that allowed her to reach remission. Today, she’s symptom-free, and her doctors have told her that her formerly inflamed tissues are healing and markers of inflammation in her blood have improved. For Amy, the best part about remission is a higher quality of life than she had when cycling between flares and treatments. “I’m a Cajun girl,” she says. “I love my spicy foods. And now I can eat what I want, I can drink coffee in the mornings, I can eat all the fruits and vegetables I want.” After nearly 15 years of flares and brief periods without symptoms, including surgical remission, Andrea Meyer, of Chicago, credits her remission to diet and mind-body therapies. She doesn’t take medications to control Crohn’s disease, but she respects her doctor’s view that it’s better to stay healthy and put up with medication side effects than to have a flare. Meyer, who cofounded the IBD awareness project The Great Bowel Movement in 2010 to empower people like her with the condition, began to improve her diet by cutting down on dairy, gluten, nuts, and processed foods and practice mind-body approaches to decrease stress and bring herself into better balance. For her, remission means a symptom-free quality of life. She still follows the recommended schedule for colonoscopies to monitor her condition.
Maximizing Remission
To improve your chances of remission, medical experts recommend taking these steps:
Work with your doctor to find the right treatment for your Crohn’s disease. Options depend on your symptoms and other personal factors, the Crohn’s & Colitis Foundation states.Take medications as prescribed. Failing to take the medications your doctor recommends can increase your risk of a flare, according to research published in April 2014 in the World Journal of Gastroenterology.Stop smoking. According to research published in the Journal of Crohn’s and Colitis, cigarette use complicates Crohn’s.Consider diet changes. A Crohn’s disease exclusion diet can be effective in adults with mild-to-moderate Crohn’s disease, according to research published in November 2021 in The Lancet. Keep in mind that this diet can be restrictive, however.Go the surgery route when necessary. About 70 percent of people with Crohn’s disease will need surgery, according to estimates from the Crohn’s and Colitis Foundation. Surgical remission, though, is not a cure: About 30 percent of the time, symptoms return within three years, the organization notes, and up to 60 percent of people will experience symptoms within a decade.
